By typing my name in the field below, I certify that answers given in this Employment Application are true, accurate and complete to the best of my knowledge. I authorize investigation into all statements I have made on this application as may be necessary for reaching an employment decision.

In the event I am employed, I understand that any false or misleading information I knowingly provided in my Employment Application or interview(s) may result in discharge and/or legal action. I understand also that if employed, I am required to abide by all rules and regulations of the employer and any special agreements reached between the employer and me.

I authorize The Delta Companies by its agents or representatives to consult with all individuals and organizations who may have information bearing on my current competence, character, and ethical qualifications.

I release from liability all representatives of The Delta Companies, and its employees, for their acts performed in good faith and without malice in connection with the evaluating of my credentials and qualifications.

I release from liability any and all individuals and organizations who provide information to The Delta Companies, and its physicians or employees, in good faith and without malice concerning my professional competence, specific training, experience, ethics, character, health and other qualifications and I consent to the release of such information.